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Abstract #51313 Published in IGR 14-3
Management algorithms for primary angle closure disease
Thomas R; Walland MJClinical and Experimental Ophthalmology 2013; 41: 282-292
Primary angle closure glaucoma and its precursors represent both a significant proportion of world glaucoma blindness and a currently insurmountable burden of treatment. In contrast to primary open angle glaucoma, preventive interventions in primary angle closure disease (PACD) can sometimes be definitive. We have synthesised data from randomised controlled trials (RCT's) - and where this is not available - principles grounded in known biology, biological plausibility, logic, preferred practice and personal experience to develop detailed and explicit clinical algorithms for the management of the spectrum of PACD. Laser iridotomy is the mainstay of first-line intervention and is usually required for all PACD with the exception of some primary angle closure suspects (PACS). Laser iridotomy is a necessary but not always sufficient step and uncertainty arises where a patent iridotomy has not alleviated the angle closure profile or achieved clinically desired end points. The crucial stepwise considerations after iridotomy are: whether the angle is open or closed; whether the IOP can be medically controlled; the extent of PAS and the presence of visually significant cataract. These lead to further interventions that include iridoplasty, cataract surgery, trabeculectomy or phacotrabeculectomy. Such subsequent interventions are based on an arbitrary threshold (180 degrees) for angle opening and extent of PAS following iridotomy and other initial procedures. It is anticipated that these clinical algorithms for the management of the PACD will be modified with further accumulation of data and experience.
Queensland Eye Institute, Brisbane, Australia; University of Queensland, Brisbane, Australia.
Full articleClassification:
9.3.5 Primary angle closure (Part of: 9 Clinical forms of glaucomas > 9.3 Primary angle closure glaucomas)
